The Afghan desert community where women are hidden away and child brides sold for $20,000

Thursday 19 May 2011 09:28 BST

Afghan Woman with children in Khan Neshin, 50 miles from the border with Pakistan

It is the malaria season in Khan Neshin, the wild south of Helmand, just 50 miles from the border with Pakistan.

Mosquitoes thrive in the fetid pools along the river. In the dry fields the last of the poppy harvest is being gathered - and this year it's a bumper crop.

The hardy community of Khan Neshin is a harsh reality check for the project to build a new Afghanistan. As a work in progress at best, the progress comes no slower than in these harsh desert lands of Baluchistan.

"At least 70 per cent of all crops here are poppy," said district governor Massoud Jan, 28, arising star in the politics of the Baluch community, who are in a slight majority here. "The soil is so full of salt the farmers believe it is the only thing guaranteed to grow."

Opium is a powerful symbol of wealth, and used as an alternative currency. Fighting disease, the mosquitoes and the heat - soon the temperature will be well over 50C - is a full-time survival game. The last attack by the Taliban was four months ago.

A sense of security coincided with the arrival of the US Marines last year. "The biggest problem is water - bad water everywhere," said Matin, who runs the Ekram Pharmacy, a mudbrick shop in the bazaar.

All his wares are for cleaning water, malaria and baby care.

"The trouble is that the sewage goes into the canal ditches, which are used for washing, drinking and cooking."

"We're getting more than 20 malaria cases a month and of those, four or five die and that will go on through the summer," explains Jilani Sherifi, 36, a pharmacist and clinician, or "barefoot doctor", at the rudimentary clinic on the edge of town.

More worrying is the condition of mothers and children. "We get about 600 births each year in a community of just over 21,000. Of these 30 per cent will die, most between the age of 10 days and one month. And at least 10 per cent - some 60 to 70 - of those mothers will die in childbirth every year. It's down to the food and the water.

The mothers just can't sustain the babies." Part of the problem is that there are no midwives and the men will not let their wives and daughters be treated by male doctors and nurses.

There is also a deeper problem weighing on the doctor's mind -as I was told by a good friend of his, Omar. "My friend told me he was really distressed by a 13-year-old brought to him by an old man in his sixties.

She was suffering from bruises and was short of breath and was in a terrible state. The man with her turned out not to be her father or grandfather but her husband. She was little more than a child and was really terrified by what that old man tried to do to her every night. It is a huge problem in Khan Neshin and of course no one wants to talk about it."

Women are hidden from public view. In two and a half days I saw only one, a nomad shrouded in a black burka, and only three girls. Young girls are traded for "bride prices" of up to $20,000 and the big payers are those rich in opium, the gangsters, middlemen and warlords.

"In some of the remote compounds we visit," a marine officer told me, "we see women and girls in appalling conditions - with noses missing, and huge ulcers and goitres on their necks."

But there is some sign of hope. Jon, from the UK's Stabilisation Unit, is supervising the building of a clinic with a dedicated midwife and female doctor. There is to be a new meeting hall and a school - though for boys only. "It's a small investment for a pretty big return but progress is very slow here in Khan Neshin.

It's sometimes difficult to explain that conflict resolution is usually about stopping a farmer hitting his neighbour over the head with a spade over rights to water."